Does Sleep Endoscopy Staging Pattern Correlate With Outcome of Advanced Palatopharyngoplasty for Moderate to Severe Obstructive Sleep Apnea?

Hsu, Ying-Shuo; Jacobowitz, Ofer

doi:10.5664/jcsm.6756

Cited by 48 publications

(44 citation statements)

References 37 publications

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“…The importance of tongue‐related obstruction has been demonstrated in previous smaller studies, whether for uvulopalatopharyngoplasty alone, palate surgery and tongue radiofrequency (performed in 86%) with or without hyoid suspension (performed in 49%), palatine tonsillectomy with or without soft palate surgery, or possibly H‐UPPP and palatal advancement pharyngoplasty . In contrast, another relatively small study questioned the importance of tongue‐related obstruction, showing similar findings with newer palate surgery techniques, regardless of whether there was complete tongue‐ and/or epiglottis‐related obstruction …”

Section: Discussionmentioning

confidence: 58%

“…This is the largest study examining the association between DISE findings and surgical outcomes. It is the only multicenter study and just the second to incorporate blinded DISE reviews . The multicenter nature of this study is a major strength because it supports the generalizability of the findings.…”

Section: Discussionmentioning

confidence: 68%

“…However, there are viable treatment options. Palate surgery techniques (other than traditional uvulopalatopharyngoplasty) such as lateral pharyngoplasty, expansion sphincter pharyngoplasty, relocation pharyngoplasty, or palatal advancement pharyngoplasty may treat oropharyngeal lateral wall‐related obstruction; the present study could not examine specific palate surgery techniques. Hypoglossal nerve stimulation and maxillomandibular advancement also may address oropharyngeal lateral wall‐related obstruction.…”

Section: Discussionmentioning

confidence: 98%

“…DISE technique is based on research indicating that upper airway physiology at the transition from consciousness to unconscious sedation has some similarities to physiology during natural sleep . Previous relatively small, single‐center studies have demonstrated that DISE may be associated with surgical outcomes, although others have had conflicting findings . These studies have been limited by their performance in single centers with small sample size.…”

Section: Introductionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

et al. 2018

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Objective To evaluate the association between findings of blinded reviews of preoperative drug‐induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. Methods Retrospective, multi‐center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. Results Two hundred seventy‐five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m2. There was moderate interrater reliability (kappa = 0.40–0.60) for DISE findings. Oropharyngeal lateral wall‐related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue‐related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum‐related obstruction or the degree of epiglottis‐related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). Conclusion DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique. Level of Evidence 2B Laryngoscope, 129:761–770, 2019

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

et al. 2018

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“…The results of the present prospective study, in a population of 14 patients who underwent MAD treatment followed by MMA surgery, show that a complete elimination of CCCp can be achieved by MMA surgery. This is of major importance, as CCCp is considered to be a negative predictive value for MAD treatment, UA surgery, and UA stimulation, and tends to be more difficult to alleviate compared to the other collapse patterns . In addition, when CCCp is present, higher CPAP pressure is needed to reopen the UA …”

Section: Discussionmentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

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Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

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Incidence of Multilevel Surgical Procedures and Readmissions in Uvulopalatopharyngoplasty in Taiwan

Hsu¹,

Hsu

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Multilevel surgical procedures with uvulopalatopharyngoplasty (UPPP) appear to be associated with more complications than UPPP alone, but general and bleeding-related hospital readmissions have not been specifically investigated to date. OBJECTIVE To compare the risk of 30-day general and bleeding-related readmissions in adult patients who underwent UPPP alone and those who received a multilevel surgical procedure. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study retrospectively analyzed all cases of UPPP among adults (aged >20 years) in Taiwan from January 1, 2000, to December 31, 2012. Claims data in the Taiwan National Health Insurance Research Database were used. Participants were patients who underwent inpatient UPPP (n = 35 029), and their basic information was acquired from the database. Data analyses were conducted from June 22, 2018, to August 22, 2018. MAIN OUTCOMES AND MEASURES The risks of major complications in patients who underwent UPPP alone, UPPP with nasal operation, and UPPP with tongue or hypopharyngeal operation were compared using a generalized linear mixed model. RESULTS In total, 35 029 adults were identified (mean [SD] age of 39.2 [12.2] years, and 25 923 men [74.0%]). The proportion of UPPP concurrent with nasal operation increased from 2000 to 2012 (19.9% to 42.9%), as did that of UPPP with concurrent tongue or hypopharyngeal operation (2.7% to 5.2%). The rate of readmission for any reason after UPPP with nasal operation was higher than that for UPPP alone (4.7% vs 3.7%; adjusted odds ratio [aOR], 1.22; 95% CI, 1.09-1.37). The rate of readmission for any reason and readmission for bleeding for UPPP with tongue or hypopharyngeal operation (aOR, 1.68; 95% CI, 1.34-2.11) was also higher than that for UPPP alone (aOR, 2.34; 95% CI, 1.72-3.17). However, a multilevel surgical procedure was not associated with an increased risk of bleeding-related reoperation, regardless of the concurrent procedure. CONCLUSIONS AND RELEVANCE The incidence of multilevel UPPP in Taiwan increased from 2000 to 2012, and these surgeries appeared to be associated with a higher risk of complications; results of this study suggest that these findings should be considered during surgical decision-making.

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Does Sleep Endoscopy Staging Pattern Correlate With Outcome of Advanced Palatopharyngoplasty for Moderate to Severe Obstructive Sleep Apnea?

Cited by 48 publications

References 37 publications

Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

Drug‐Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Incidence of Multilevel Surgical Procedures and Readmissions in Uvulopalatopharyngoplasty in Taiwan

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